COVID-19 is an emerging, rapidly evolving situation.
Get the latest public health information from CDC:

Get the latest research information from NIH: Menu

ABRA Abdominal Closure System in Open Abdomen Management (ABRA)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00754156
Recruitment Status : Completed
First Posted : September 17, 2008
Results First Posted : March 18, 2014
Last Update Posted : March 3, 2017
Information provided by (Responsible Party):
Anna Rockich, University of Kentucky

Brief Summary:

For the last 20 to 30 years, damage control laparotomy and decompressive laparotomy have emerged as part of the armamentariums for treatment of complex abdominal trauma, abdominal compartment syndrome, and critically ill surgical patients with profound acidosis. While these advances have saved lives, they have also led to a dramatic increase in patients with open abdominal cavities. Various methods have been employed to offer protection to the viscera and at the same time, encourage gradual closure of the abdominal fascia. Some of the techniques have included the Bogota bag, vacuum pack described by Barker , Wittman patch , and the use of vacuum assisted fascia-closure, including the commercially available system offered by KCI. Overall, the abdominal closure rate is approximately 50% to 90% over an average of 10 days. Unfortunately, there has been no well-designed comparison study available. Some of the best results also require returning to the operating room every 3 to 5 days.

At the University of Kentucky Medical Center, a combination of the vacuum pack dressing described by Barker, the commercially available VAC system (V.A.C.; KCI International, San Antonio, TX) and vicryl mesh closure systems are used. The primary fascial closure rate is approximately 50%. It is not standard practice to take patients to the OR every 3-5 days routinely.

Recently, a new FDA listed system (ABRA by Canica) has been introduced using a progressive tension system as a novel approach to the management of open abdomen. ABRA provides a dynamic reduction of full thickness, severely retracted midline abdominal defects with the goal of maintaining or restoring the primary closure option. This subdermal method uses button anchors and elastomer to gradually pull the wound margins together. Tension can be set and adjusted according to the desired outcome; to stabilize a retracted wound, reduce the wound, close the wound or prevent wound dehiscence (Attachment 1: Company brochure). Currently there is only one published case report of the success of this device. We hope to be the first center to prospectively report a series of patients with open abdomen managed with the new ABRA system. In this study, this system will be used in combination with a standard therapy used in abdominal wound closure at the University of Kentucky Medical Center. This system is called the V.A.C system (V.A.C.; KCI International, San Antonio, Tx). This therapy provides active exudate management and containment, assists in reducing abdominal volume and adds structural stabilization to adipose tissue.

Although no highly powered study has been done to establish data on performance, individual experiences at several institutions have reached fascial closure rates of higher than 70% using the ABRA device. One institution in Las Vegas, Nevada is using the ABRA device in combination with the VAC system and has experienced 100% closure rate to date with 12 patients. The purpose of this study is to collect information about the ABRA system in combination with the VAC technique at the University of Kentucky Medical Center. It is our belief that using this system will improve the fascial closure rate and thereby produce less chance of hernia and reduce long periods of open abdominal wounds. The objective of the study is to evaluate a novel approach for closure of open abdomen utilizing the Canica ABRA system combined with the K.C.I. VAC System to KCI VAC System alone.

Condition or disease Intervention/treatment Phase
Open Abdomen Device: ABRA Abdominal Closure System Device: V.A.C. Therapy Device: KCI ABThera Phase 4

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 14 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Prospective, Controlled Evaluation of ABRA Abdominal Wall Closure System in Combination With V.A.C. Therapy Compared to V.A.C. Alone in the Management of Open Abdomen
Study Start Date : September 2008
Actual Primary Completion Date : December 2011
Actual Study Completion Date : December 2011

Arm Intervention/treatment
Active Comparator: 1 ABRA plus KCI ABThera or KCI VAC
ABRA Abdominal Wound Closure System in combination with KCI ABThera or KCI VAC
Device: V.A.C. Therapy
V.A.C. Therapy Alone

Device: KCI ABThera

Active Comparator: KCI V.A.C. Therapy or ABThera Alone
KCI V.A.C. Therapy ABThera Alone
Device: ABRA Abdominal Closure System
ABRA Abdominal Closure System

Device: V.A.C. Therapy
V.A.C. Therapy Alone

Device: KCI ABThera

Primary Outcome Measures :
  1. Primary Closure Rate [ Time Frame: up to 12 months ]
    The rate in which the abdomen was closed the first time.

  2. Number of Trips to the Operating Room [ Time Frame: 12 Months ]
  3. Operating Room Time Utilization [ Time Frame: Duration of Hospital Stay less than 6 months ]
    The amount of time needed to manage the open abdomen inside the operating room.

Secondary Outcome Measures :
  1. Days to Closure [ Time Frame: Duration of Hospital Stay less than 6 months ]
  2. ICU Days [ Time Frame: Duration of hospital stay less than 6 months ]
  3. Hospital Days [ Time Frame: Duration of Hospital Stay less than 6 months ]
  4. Blood Transfused [ Time Frame: Duration of Hospital Stay less than 6 months ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Layout table for eligibility information
Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. ages of 18 and 70
  2. patients deemed not a candidate for primary fascial closure at the second laparotomy.

Exclusion Criteria:

  1. High risk for imminent death, as determined by the attending surgeon and PI
  2. Pre-existing large ventral hernia
  3. Significant loss of abdominal wall fascia as a result of trauma or infection
  4. Known Crohn's disease
  5. Pregnancy

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00754156

Layout table for location information
United States, Kentucky
University of Kentucky Medical Center
Lexington, Kentucky, United States, 40536
Sponsors and Collaborators
Anna Rockich
Layout table for investigator information
Principal Investigator: Phillip Chang, M.D. University of Kentucky
Layout table for additonal information
Responsible Party: Anna Rockich, Director, General Surgery Clinical Research Program, University of Kentucky Identifier: NCT00754156    
Other Study ID Numbers: 07-0694-F2L
First Posted: September 17, 2008    Key Record Dates
Results First Posted: March 18, 2014
Last Update Posted: March 3, 2017
Last Verified: February 2014
Keywords provided by Anna Rockich, University of Kentucky:
Closure, Wounds